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The question of heart failure in ONTARGET and TRANSCEND: implications for clinical practice

José R González-Juanatey1

  • 1Cardiology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain. jose.ramon.gonzalez.juanatey@sergas.es

Journal of Hypertension. Supplement : Official Journal of the International Society of Hypertension
|June 4, 2009
PubMed

Insights

Blood pressure reduction and renin-angiotensin system (RAS) inhibitors like ACE inhibitors and ARBs lower heart failure risk in high-risk patients. Studies ONTARGET and TRANSCEND confirm these findings, showing similar efficacy in preventing heart failure.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Arterial hypertension and high cardiovascular risk increase heart failure incidence.
  • Inhibition of the renin-angiotensin system (RAS) with ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) reduces cardiovascular risk.
  • Previous studies suggest blood pressure reduction is key to preventing heart failure.

Purpose of the Study:

  • To evaluate the heart failure incidence in patients treated with telmisartan alone or in combination with ramipril.
  • To compare the efficacy of telmisartan and ramipril in preventing heart failure.
  • To assess the role of RAS inhibition in heart failure prevention within the ONTARGET and TRANSCEND trials.

Main Methods:

  • Analysis of heart failure incidence data from the ONTARGET and TRANSCEND clinical trials.
  • Comparison of telmisartan and ramipril efficacy in heart failure prevention.
  • Evaluation of blood pressure reduction and its correlation with heart failure events.

Main Results:

  • Heart failure incidence in ONTARGET and TRANSCEND aligns with the known benefits of blood pressure reduction and RAS inhibition.
  • Telmisartan and ramipril demonstrated equal effectiveness in preventing heart failure in ONTARGET, achieving similar blood pressure reductions.
  • The TRANSCEND trial showed a low heart failure incidence, potentially influenced by increased diuretic use in the placebo arm, obscuring significant differences between telmisartan and placebo.

Conclusions:

  • Blood pressure reduction and RAS inhibition are effective strategies for decreasing heart failure risk in hypertensive and high-risk patients.
  • Telmisartan and ramipril show comparable efficacy in heart failure prevention.
  • Further research may be needed to fully elucidate telmisartan's specific role in heart failure prevention, considering trial-specific factors like concomitant medication use.

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